Prevalence of Some Opportunistic Infections (OIs) and Co-infections among HIV-Infected Persons in Port Harcourt, Nigeria

Main Article Content

Iheanyi O. Okonko
Hope Onwusor
Amaka M. Awanye
Tochi I. Cookey
Charles C. Onoh
Sophia Adewuyi- Oseni

Abstract

Aim: HIV/AIDS continues to spread globally and remains a worldwide pandemic. Opportunistic infections (OIs) occur more and are severe in people living with HIV who have weakened immune systems, and co-infection is another major challenge because it affects the rate to which the disease progress to AIDS. In the present study, a total of 100 HIV positive patients were recruited and evaluated for the presence of common opportunistic infections (OIs) and co-infections among HIV-infected individuals in Port Harcourt, Nigeria.

Study Design: Cross-sectional study.

Place and Duration of Study: Prime Medical Consultants in Port Harcourt, Nigeria, between June 2012 and July 2015.

Methods: A total of 100 HIV-infected individuals were recruited for this study (ages 1 to 70 years, 62 males and 38 females). Samples of blood, sputum, high vaginal swabs (HVS) and scrapped lesion from the mouth of the patients were collected. Blood samples were re-screened for the presence of HIV antibodies and HBsAg using the Determine HIV-1/2 (Alere), HIV ½ Stat-Pak (Chembio), HIV-1/2/P24/O ELISA kit and HBsAg one Ultra ELISA kit (Dia.Pro) following the respective manufacturer's instructions. The Ziehl-Neelsen sputum smear microscopy method was used for identifying tuberculosis (TB). Microscopical examination was done on HVS samples and lesions scrapings from the mouth to observe for Candida. Chi-square test was used to establish relationships between demographic factors and prevalence, and significance level was set at P ≤ 0.05.

Results: Of the 100 HIV positive patients, suspected case were 32.0% of TB, 28.0% of oral thrush and vaginosis, and 19.0% of hepatitis. The results of the laboratory analysis further showed that tuberculosis was the most common OI among others. Overall prevalence was 22.0% for TB, 11.0% for Candida albicans (oral thrush), 28.9% for Candida albicans (vaginosis) and 4.0% for HBV.  Higher prevalence of TB was observed in the age groups 41 years & above (35.7%, P=0.14) and in males (22.6%, P=0.86). As for Candida albicans, the higher prevalence was found in age groups 21-40 years (19.1%, P=0.03) and in females only (28.9%), and higher prevalence of HBV was found in age groups 41 years & above (9.1%, P=0.78) and in females (5.3%, P=0.61). None of the variables (age and sex) evaluated in this study was statistically associated (P>0.05) with TB, Candida and HBV prevalence.

Conclusion: The study has also shown that some opportunistic infections (candidiasis and Tuberculosis) and coinfections with HBV is prevalent among HIV infected individuals and this could largely be due to a compromised immune system as a result of the viral activities in the host cell. There is need therefore to routinely check for OIs and co-infections especially in the case of an immunocompromised individual. It is also imperative to note that the appropriate use of drugs against these OIs may be one of the strategies to extend the life span of AIDS patients. This will help to monitor how the disease progresses and its complications.

Keywords:
HIV, HBV, TB, Candida albicans, prevalence, Nigeria.

Article Details

How to Cite
Okonko, I. O., Onwusor, H., Awanye, A. M., Cookey, T. I., Onoh, C. C., & Oseni, S. A.-. (2020). Prevalence of Some Opportunistic Infections (OIs) and Co-infections among HIV-Infected Persons in Port Harcourt, Nigeria. South Asian Journal of Research in Microbiology, 8(1), 1-12. https://doi.org/10.9734/sajrm/2020/v8i130182
Section
Original Research Article

References

World Health Organization (WHO); 2020a. Available:https//:www.who.int/gho/hiv/epidemic_status/prevalence_text/en/

Okonko IO, Adewuyi SA, Omatsone C, Cookey TI. Detection of hepatitis B virus among HIV positive fresh undergraduate students in Port Harcourt, Nigeria. Asian Journal of Research and Reports in Gastroenterology. 2020a;3(3):8-13.

Konopnicki D, Mocroft A, De Wit S, Antunes F, Ledergerber B, Katlama C. Hepatitis B and HIV: Prevalence, AIDS progression, response to highly active antiretroviral therapy and increased mortality in the EuroSIDA cohort. AIDS. 2005;19(6):593-601.

Okonko IO, Ejike IU, Innocent-Adiele HC, Cookey TI. HIV coinfections with tuberculosis among HIV-1 infected individuals in old Cross River State, Nigeria. Journal of Immunoassay and Immunochemistry. 2020b;41(3):245-256.

Anwar KP, Malik A, Subhan KH. Profile of candidiasis in HIV infected patients. Iran J Microbiol. 2012;4(4):204-209.

Center for Disease Control and Prevention. AIDS and opportunistic infections. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Centers for Disease Control and Prevention, USA; 2019. Available:https://www.cdc.gov/hiv/basics/livingwithhiv/opportunisticinfections.html [Accessed August 7, 2020]

Nissapatorn V, Sawangjaroen N. Parasitic infections in HIV infected individuals: Diagnostic & therapeutic challenges. Indian J Med Res, 2011;134(6):878- 897.

Boston University Department of Infectious Diseases (BUDID). The Importance of tuberculosis research. Tuberculosis Research Unit, Department of Infectious Diseases, Boston University; 2020. Available:https://www.bumc.bu.edu/tbru/10-2/the-importance-of-tuberculosis-research/ [Accessed August 9, 2020]

World Health Organization (WHO). Tuberculosis fact sheet; 2020b. Available:https://www.who.int/news-room/fact-sheets/detail/tuberculosis [Accessed August 9, 2020]

UNAIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic 2017; UNAIDS: Geneva; 2017.

Ugochukwu EF. HIV/TB co-infection in Nigerian children. Niger. Med. J. 2010;51(3):120.

World Health Organization. Global Tuberculosis Report 2015. World Health Organization; 2015.

The National Tuberculosis and Leprosy Control Programme (NTBLCP). World TB day 2019 – Press Release: It’s time – to end TB in Nigeria. Keep the Promise! Find TB! Treat TB! Federal Ministry of Health, Abuja, Nigeria; 2019. Available:http://ntblcp.org.ng/press-room/world-tb-day-2019-%E2%80%93-press-release [Accessed December 21, 2019]

Khan AP, Malik A, Khan SH. Profile of candidiasis in HIV infected patients. Iranian Journal of Microbiology; 2012.

Xavier TF, Auxilia A. Prevalence of Candida infection in HIV seropositive patients in Karur district of Tamil Nadu, India. International Journal of Current Microbiology and Applied Sciences. 2014;3(5):312-317.

Kouassi-M’Bengue A, Ouattara A, Allah-Kouadio E, Sevede D, Doumbia M, Dosso M. A very high frequency of hepatitis B and C virus infections during an active screening campaign in Abidjan. African Journal of Microbiology Research. 2017;11(1):8-15.

World Health Organization (WHO). Hepatite B. Aide Memoire. 2013;204.

World Health Organization (WHO); 2019. Available:https//:www.who.int/news-room/fact-sheets/detail/hepatitis-b

Adewole OO, Anteyi E, Ajuwon Z, Wada I, Elegba F, Ahmed P, Betiku Y, Okpe A, Eze S, Ogbeche T, Erhabor GE. Hepatitis B and C virus co-infection in Nigerian patients with HIV infection. Journal of Infection in Developing Countries. 2009;3(5):369-375.

Ogbonna DN, Amangabara GT, Ekere TO. Urban solid waste generation in Port Harcourt metropolis and its implications for waste management. Management of Environmental Quality: An International Journal. 2007;18(1).

National Population Commission (NPC). Census of the Federal Republic of Nigeria. Federal Republic of Nigeria, Abuja, Nigeria; 2006.

Macfarlane SB. Conducting a descriptive survey: 2. choosing a sampling strategy. Tropical Doctors. 1997;27(1):14-21.

Niang L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Archives of Orofacial Sciences. 2006;1:9–14.

Itah AY, Udofia SM. Epidemiology and endemicity of pulmonary tuberculosis (PTB) in Southeastern Nigeria. Southeast Asian J. Trop. Med. Public Health. 2005;36:317–323.

Edike M. Nigeria: Funds threaten Enugu HIV/AIDS campaign. In Vanguard Newspaper, 1st Ed. Vanguard Media, Lagos, Nigeria. 2008;15.

Kooffreh ME, Offor JB, Ekerette EE, Udom UI. Prevalence of tuberculosis in Calabar, Nigeria: A case study of patients attending the outpatients department of Dr Lawrence Henshaw Memorial Hospital, Calabar. Saudi. J. Health Sci. 2016;5:130–133.

Okonko IO, Anyanwu A, Osadebe A, Odu N. HIV and tuberculosis co-infection in a highly HIV-infected population of Rivers State, Nigeria. Journal of Immunoassay Immunochemistry. 2018;39(6):636–646.

Harling G, Newell ML, Tanser F, Kawachi I, Subramanian S, Bärnighausen T. Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural Kwa Zulu-Natal, South Africa. JAIDS Journal of Acquired Immunodeficiency Syndromes. 2014;66(4):443−451.

Oko-Jaja RI, Igbigbi EE. Pattern and prevalence of HIV and tuberculosis infection in Port Harcourt Nigeria. International Journal of Novel Research in Healthcare and Nursing. 2017;4(2):1- 6.

Lawson L, Lawson JO, Olajide I, Ememyonu N, Bello CS, Olatunji OO, Davies PD, Thacher TC. Sex differences in the clinical presentation of urban Nigerian patients with pulmonary Tuberculosis. West Afr. J. Med. 2008;27:82–86.

Odaibo GN, Okonkwo P, Lawal OM, Olaleye DO. HIV infection among newly diagnosed TB patients in Southwestern; A multi-DOTS center study: Nigeria; 2013.

Pappas PG, Rex JH, Lee J, et al. A prospective observational study of candidemia: Epidemiology, therapy and influences on mortality in hospitalized adult and pediatric patients. Clinical Infectious Diseases. 2003;37(5):634–643.

Kalpesh M, Govind N, Mitesh K. Prevalence of Candida species among HIV positive patients at a tertiary care hospital. Int J Res Med. 2015;4(2);100-104.

Pruthvi BC, Vikram S, Suman SK, Jayaprakash B, Rau NR. 13th International Congress on Infectious Diseases. Spectrum of Clinical Presentation and Opportunistic Infections in HIV: An Indian Scenario. 2006;e484.

Nagalingeswaran K, Solomon S, Madhivanan P, Yepthomi T, Venkatesan C, Amalraj E, et al. Correlation between plasma viral load and CD4+T cell count to opportunistic infections in persons with HIV in South India. Int Conf AIDS. 2000;9-14:13.

Singh A, Bairy I, Shivananda PG. Spectrum of opportunistic infections in AIDS cases. Int Conf AIDS. 2003;57:16–21.

Germain G, Laverdiere M, Pelletier R. Prevalence and antifungal susceptibility of 442 Candida isolates from blood and other normally sterile sites, multicentre surveillance study in Quebec, Canada. J Clin Microbiology. 1998;39:949-953.

Anupriya W, Ravinder K, Satish KA, Shyama J, Preena B. AIDS-related opportunistic mycoses seen in a tertiary care hospital in North India. Journal of Medical Microbiology. 2007;56:1101–1106.

Rudramurthy KG, Ramya K, Geetha RK. Phenotypic characterization and antifungal susceptibility pattern of Candida sp. isolated from a tertiary care center. Journal of Evolution of Medical and Dental Sciences. 2014;3(09):2094-2097.

Mulla SA, Patel MG, Vaghela G, Motala N, Desai V, Shrivastava RK. A study of opportunistic infection in HIV-seropositive patients. Indian J Community Med. 2007;32:208–9.

Ismail HS, Jose LM, Elena E, Miguel M, María DM, Jose MA, et al. Evaluation of CHROM-Pal medium for the isolation and direct identification of Candida dubliniensis in primary cultures from the oral cavity. Journal of Medical Microbiology. 2009;58:1437–1442.

Shah R, Parul Chaturvedi P, Pandya HP. Prevalence of Candida from Sputum in HIV infected patients of Gujarat, India. Int. J. Curr. Microbiol. App. Sci. 2014;3(8):345-357.

Ito CY, de Paiva MCA, Loberto JC, dos Santos SS, Jorge AO. In vitro antifungal susceptibility of Candida spp. isolates from patients with chronic periodontitis and from control patients. Braz Oral Res. 2004;18:80-84.

Wabe NT, Hussein J, Suleman S, Abdella K. In vitro antifungal susceptibility of Candida albicans isolates from oral cavities of patients infected with human immunodeficiency virus in Ethiopia. Journal of Experimental and Integrative Medicine. 2011;1(4):265- 271.

Mousavi SAA, Salari S, Rezaie S, Nejad NS, Hadizadeh S, Kamyabi H, Aghasi H. Identification of Candida species isolated from oral colonization in Iranian HIV-positive patients, by PCR-RFLP method. Jundishapur Journal of Microbiology. 2012;5(1):336-340.

Schmidt-Westhausen A, Schiller RA, Pohle HD, Reichart PA. Oral Candida and Enterobacteriaceae in HIV-1 infection: Correlation with clinical candidiasis and antimycotic therapy. J Oral Pathol Med. 1991;20:469–472.

Tsang CS, Samaranayake LP. Oral yeasts and coliforms in HIV infected individuals in Hong Kong. Mycoses. 2000;43:303–308.

Agwu E, Ihongbe JC, McManus BA, Moran GP, Coleman DC, Sullivan DJ. Distribution of yeast species associated with oral lesions in HIV infected patients in Southwest Uganda. Med. Mycol. 2012;50(3):276–280.

Nweze EI, Ogbonnaya UL. Oral Candida isolates among HIV infected subjects in Nigeria. J Microbiol Immunol Infect. 2011;44(3):172-177.

Okonkwo EC, Alo MN, Nworie O, Orji JO, Agah MV. Prevalence of oral Candida albicans infection in HIV sero-positive patients in Abakaliki. American Journal of Life Sciences. 2013;1(2):72-76.

Enwuru CA, Ogunledun A, Ogbonna F, Enwuru NV, Aneidobe M, Adeiga A. Fluconazole resistant opportunistic oropharyngeal Candida and non- Candida yeast-like isolates from HIV infected patients attending ARV clinics in Lagos, Nigeria. J Afr Health Sci. 2008;18(3):142-148.

Ndukwu CB, Mbakwem-Aniebo C, Frank-Peterside N. Prevalence of Candida species among HIV positive patients in two tertiary hospitals in rivers state. IOSR Journal of Pharmacy and Biological Sciences (IOSR-JPBS). 2016;11(5 Ver. III):79-81.

Lar PM, Pam KV, Tiri Y, Olukose S, Yusuf A, Dashen MM, Mawak JD. Prevalence and distribution of Candida species in HIV infected persons on antiretroviral therapy in Jos. Journal of Medicine and Medical Science. 2012;3(4):254-259.

Thanyasrisung P, Kesakemol P, Pipattanagovit P, Yaungnak-Piboonratanakit P, Pitiphat W, Matangkasombut O. Oral Candida carriage and immune status in Thai human immunodeficiency virus-infected individuals. Journal of Medical Microbiology. 2014;63:753–759.

Costa CR, Cohen AJ, Fernandes OFL, Miranda KC, Passos KS, Souza AKH, Silva RR. Asymptomatic oral carriage of Candida species in HIV-infected patients in the highly active antiretroviral therapy era. Rev. Inst. Med. Trop. 2006;48:257–261.

Avwioro OG, Ekene EN, Afadu TE. HIV and HBV coinfection in Niger-Delta, Nigeria. African Journal of Cellular Pathology. 2014;2:48-52.

Adoba P, Boadu SK, Agbodzakey H, Somuah D, Ephraim RK, Odame EA. High prevalence of hepatitis B and poor knowledge on hepatitis B and C viral infections among barbers: A cross-sectional study of the Obuasi municipality, Ghana. BMC Public Health. 2015;15(1041):1-7.

Coppola N, Loredana A, Mariantonietta P, Margherita M, Caterina S, Rosa Z, Evangelista S. Hepatitis B virus infection in immigrant populations. World J Hepatology. 2015;7(30):2955-2961.

Taye S, Abdulkerim A, Hussen M. Prevalence of hepatitis B and C virus infections among patients with chronic hepatitis at Bereka Medical Center, Southeast Ethiopia: A retrospective study. BMC Res. Notes. 2014;7:272.

Aliyu B, Manga SB, Isa MA. Prevalence of hepatitis B virus among HIV positive patients attending specialist hospital Sokoto, Nigeria. International Journal of Environment. 2013;2(1):37-44.

Kye-Duodu G, Nortey P, Malm K, Nyarko KM, Sackey SO, Ofori S, Afari EA. Prevalence of hepatitis B virus co-infection among HIV-seropositive persons attending antiretroviral clinics in the Eastern Region of Ghana. The Pan African Medical Journal. 2016;25(1): 6172.

Makuwa M, Mintsa-Ndong A, Souqui`ere S, Nkogh´e D, Leroy ME, Kazanji M. Prevalence and molecular diversity of hepatitis B virus and hepatitis delta virus in urban and rural populations in Northern Gabon in Central Africa. J. Clin. Microbiol. 2009;47(7):2265-2268.

Ekanem US, Eyoh JE, Esubok NU. Prevalence of hepatitis- B virus infection among HIV patients seen in the University of Uyo Teaching Hospital (UUTH), Uyo. International Journal of Research in Biosciences. 2013;2(1):92-98.

Deng QJ, Pan YQ, Wang CY. Prevalence and risk factors for hepatitis B in Hua County. Henan Province, Beijing Da Xue Xue Bao, 2013;45:965-970.